Environmental interventions for preventing falls in older people living in the community: A Cochrane Systematic Review
Alison Pighills1 1Mackay Hospital and Health Service, Mackay, Queensland, Australia2James Cook University, Townsville, Queensalnd, Australia
Abstract
Clemson, L.1, Stark, S.2, Pighills, A.3, Sherrington, C1
1The University of Sydney, Sydney, NSW, Australia
2Washington University, St. Louis, USA
3Mackay Hospital and Health Service & James Cook University, Mackay QLD, Australia
Background
Environmental interventions aim to reduce falls in older people and include home fall hazard reduction, assistive technology, education and home modifications. This review updates the previous evidence for environmental interventions in fall prevention.
Method
Central, Medline, CINAHL, Embase and trial registries were searched (to February 2021) for randomised controlled trials. Screening and data extraction were conducted according to Cochrane procedures. The primary outcome was rate of falls (number of falls/time in study) and secondary analysis included risk of falls (number of fallers) and several a priori sub-analysis.
Results
We included 22 studies from 10 countries involving 8463 older people. Home fall-hazard interventions reduced the rate of falls by 26% (rate ratio (RaR) 0.74, 95% confidence interval (CI) 0.61 to 0.91. p=0.005; 12 studies, 5293 participants; moderate-certainty evidence). These interventions were more effective (38% reduction) in people at high falls risk (RaR 0.62, 95% CI 0.56 to 0.70, P<0.00001; 9 studies, 1513 participants; high-certainty evidence). There was no reduction in falls in people at low falls risk (RaR 1.05, 95% CI 0.96 to 1.16, p=0.28; 6 studies, 3780 participants; high-certainty evidence).
Conclusion
We found high-certainty evidence that home fall-hazard interventions are effective in reducing the rate of falls and the number of fallers, when targeted to people at higher risk of falling. There was no evidence of effect when targeted toward people at low risk of falling.
There was insufficient evidence to determine whether assistive technology, education and home modifications reduce falls.
Biography
Occupational therapist with 15yrs of postdoctoral research experience in environmental interventions for falls prevention in older people and an international research leader in this field. Her publications have been highlighted in Cochrane Systematic Reviews and she is a co-author of the 2023 Cochrane Systematic Review “Environmental interventions for preventing falls in older people living in the community” and the 2022 “World guidelines for falls prevention and management for older adults: a global initiative”.Principal Investigator and Chief Investigator in two randomized trials investigating the effectiveness of environmental assessment and modification for falls prevention, and in translational research projects implementing this intervention.